Is Your Drinking Making You an Almost Alcoholic?

Interview with Robert Doyle, MD, DDS co-author of Almost Alcoholic: Is My (or My Loved One's) Drinking a Problem?

Rosenberg: Your new book addresses people who have not become full alcoholics but are in a gray zone where they have developed a relationship or "commitment" to alcohol and might be termed "Almost Alcoholics." You write that drinking could already be subtly diminishing their quality of life even though serious alcohol-related problems have not erupted yet. Can you elaborate?

Doyle: I can give an example from my own life. A year ago during my physical, my doctor noted that my blood pressure, usually at the low end of normal, had crept up to the high end of the normal range. It was still in the normal range, but borderline. This made me reassess my diet and commit to more regular exercise. This January, my blood pressure was back at the low end of normal. If my blood pressure went above the normal range, it might be a mark on my record that would cause insurance companies to raise my premium fees or perhaps cause problems with changing plans. I was not going to take the chance, so I took action.

The same can happen with Almost Alcoholic drinking patterns. Why wait until a DUI traffic violation or a reprimand at work to change course? Remember, Almost Alcoholic patterns may be affecting people around you. Even if you don't think that drinking directly causes you problems, ask yourself if others around you suffer from your drinking. Often change is easier in the Almost Alcoholic phase, so consider a change now.

Rosenberg: You write in the book about people who seek help for insomnia, depression, anxiety, anger and physical problems like diabetes only to discover that alcohol may be a silent contributor or the main problem.

Doyle: People wonder why they wake up in the middle of the night after heavy drinking and then can't get back to sleep. Studies show that even one glass of wine can affect a person's sleep architecture. Sleep problems show up in many psychiatric disorders, such as depression, anxiety, and others. People who are depressed might think that alcohol is helping because the first drink seems to act as an antidepressant. After the first drink or so, alcohol starts to act as a depressant. If a person is having problems with sleep, energy, concentration, and memory may be off the next day. These are some of the same symptoms seen in depression and certain anxiety disorders. Patients sometimes think that they need a medication for depression or anxiety.

Many times they might, but the best approach is to see if the alcohol is at the root of their problems. If so, stopping or cutting back on alcohol is better than adding a medication. Most psychiatric medications have side effects, and they often don't work as well as they should or might even be dangerous if a person continues to drink alcohol. I find that most people today prefer a holistic or natural approach to treatment. Reducing or eliminating alcohol gives people a natural option to try first.

Rosenberg: Many heavy drinkers, including the people whose stories are in Almost Alcoholic, think alcohol works as a way of coping. Why doesn't it?

Doyle: Alcohol "disinhibits" you and so you may do or say something you will regret later. It removes the filter on emotions. I recently heard a comic say alcohol should have more meaningful warnings on the label. For example, the warning might say, "The contents of this bottle have been known to cause humans to lose their jobs." Or, "Warnings: Alcohol is know to result in bloody noses or head injuries in certain bar settings. Alcohol can cause undue embarrassment on the dance floor. The U.S. Surgeon General recommends avoiding alcohol to reduce the risk of pregnancy, especially with someone you met shortly before the bar closed." One must realize that alcohol causes disinhibition, and that is different from becoming in touch with one's inner emotions.

Rosenberg: There are stories in the book in which Almost Alcoholics pursue "radical acceptance" of themselves by looking deeply into their own characters. Jamal, who grew up with an abusive father and learned he did not have the right to stand up for himself, is able to reverse the pattern with his own children. Maria is able to feel self-love for the first time in her life after four weeks of not drinking. These sound a lot like Step 4 of Alcoholics Anonymous-"made a searching and fearless moral inventory of ourselves." How can people who do not term themselves "alcoholics," join AA or get an AA sponsor approach such a character assessment?

Doyle: People who might be Almost Alcoholics can get guidance, support and feedback from many sources. These range from safe therapeutic relationships with a professional counselor to feedback from trusted friends, spouses and other family members. The key is acceptance and a willingness to be honest about themselves. There is also a role for service work for Almost Alcoholics-working with others as people do in the anonymous 12 Step Programs.

Some people may not want to commit to 12 Step programs but they can find other outlets in which they can make a positive impact with other people. I think persons who are Almost Alcoholic will find parts of the Big Book of Alcoholics Anonymous helpful even if they do not attend AA meetings. Adult Children of Alcoholics (ACOA) meetings follow a similar format as AA meetings, yet many of the people who attend have never had a drink. Perhaps one day, we might see Almost Alcoholics Anonymous (AAA) meetings.

Rosenberg: In alcoholism circles there is a saying that you can't turn a pickle back into a cucumber which means that if someone is really an alcoholic, they will never drink normally again. Yet you have stories of people who have left the Almost Alcoholic zone and can raise a glass or two without disastrous consequences now and then. Can you explain?

Doyle: As we show in charts in the book, people move along a spectrum from social drinking to Almost Alcoholic drinking patterns to alcohol abuse with the worse scenario ending with alcohol dependence. In hindsight, some people can say that they became alcoholic the first time they had a drink; however, most people do not know that they will be alcoholic until too late. People who are in the Almost Alcoholic range are having problems or are causing problems for others. Although we cannot be certain about who will become a true alcoholic, most people do pass through the Almost Alcoholic phase on their way to alcoholism.

people with a strong family history of alcoholism, they sprint from social drinking into alcoholism. Their time as an Almost Alcoholic is brief and they probably will not see the dead end of alcoholism ahead. On the other hand, my co-author and I treat many people who recognize that their Almost Alcoholic behavior is leading them down the wrong path.

Our book, Almost Alcoholic, provides a road map of the territory between social drinking and alcoholism. At the same time, it offers advice on changing behaviors and finding an alternate route in a safer direction. Think of Almost Alcoholic as a GPS device to help people find a healthier relationship with alcohol.

A nationally recognized expert on alcoholism, Robert Doyle, MD is a clinical instructor in psychiatry at Harvard Medical School and is on the medical staff at Harvard's prestigious teaching hospital, Massachusetts General Hospital.

Clinical psychologist Joseph Nowinski, PhD, was assistant professor of Psychiatry at the University of California-San Francisco and associate adjunct professor of Psychology at the University of Connecticut. He is currently a columnist for the Huffington Post and works in private practice.

Martha Rosenberg is a columnist and cartoonist, who writes about public health Read more stories by Martha Rosenberg.

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